Pastore M, Willems M, Cornu C, Buts J P, Reding R, de Ville de Goyet J, Rahier J, Otte J B, Yap S H, Sokal E M
Department of Paediatrics, Virology, and Surgery, Cliniques St Luc, Catholic University of Louvain, Brussels, Belgium.
Arch Dis Child. 1995 May;72(5):403-7. doi: 10.1136/adc.72.5.403.
Paediatric orthotopic liver transplant recipients may develop chronic hepatitis after surgery. To investigate the role of hepatitis C virus in this pathology a cohort of 249 paediatric orthotopic liver transplant recipients was studied. Sixteen children (6.4%) were found to have chronic hepatitis C virus hepatitis after orthotopic liver transplantation. All but one of them had serum transaminase values which were persistently raised two to eight times the upper limit of normal. Thirteen were positive for both serology and serum hepatitis C virus RNA. Serum hepatitis C virus RNA detection occurred five to 33 months before hepatitis C virus antibodies. Liver tissue hepatitis C virus RNA and hepatitis C virus core antigen were detected in five. In one patient, tissue hepatitis C virus core antigen was detected when other tests for hepatitis C were negative. Two patients had positive human cytomegalovirus serum antibodies and RNA before transplantation. Although serum hepatitis C virus RNA was not detected after transplantation, serum enzyme immunosorbent assay and tissue core antigen were still detectable in both patients. In another child, serum hepatitis C virus RNA was positive and hepatitis C virus core antigen was found on a liver biopsy specimen but antihepatitis C virus antibodies were negative as well as liver hepatitis C virus RNA. No patient developed severe liver disease or cirrhosis during a follow up of up to 72 months. It is concluded that hepatitis C virus is a significant cause of morbidity after paediatric orthotopic liver transplantation. Diagnosis cannot rely on serological testing only. The patients remained stable on follow up, but longer prospective histological studies remain necessary to establish prognosis.
小儿原位肝移植受者术后可能会发生慢性肝炎。为了研究丙型肝炎病毒在这种病理情况中的作用，对一组249例小儿原位肝移植受者进行了研究。发现16名儿童（6.4%）在原位肝移植后患有慢性丙型肝炎病毒肝炎。除1人外，他们所有人的血清转氨酶值持续升高至正常上限的2至8倍。其中13人血清学和血清丙型肝炎病毒RNA均呈阳性。血清丙型肝炎病毒RNA检测在丙型肝炎病毒抗体出现前5至33个月。5例检测到肝组织丙型肝炎病毒RNA和丙型肝炎病毒核心抗原。在1例患者中，当其他丙型肝炎检测均为阴性时，检测到组织丙型肝炎病毒核心抗原。2例患者在移植前血清人巨细胞病毒抗体和RNA呈阳性。尽管移植后未检测到血清丙型肝炎病毒RNA，但这两名患者的血清酶免疫吸附试验和组织核心抗原仍可检测到。在另一名儿童中，血清丙型肝炎病毒RNA呈阳性，肝活检标本中发现丙型肝炎病毒核心抗原，但抗丙型肝炎病毒抗体阴性，肝丙型肝炎病毒RNA也为阴性。在长达72个月的随访中，没有患者发生严重肝病或肝硬化。结论是，丙型肝炎病毒是小儿原位肝移植后发病的重要原因。诊断不能仅依靠血清学检测。患者在随访中病情保持稳定，但仍需要进行更长时间的前瞻性组织学研究以确定预后。
